Published online Mar 31, 2008.
https://doi.org/10.4070/kcj.2008.38.3.161
Predictive Factors of Major Adverse Cardiac Events and Clinical Outcomes of Acute Myocardial Infarction in Young Korean Patients
Abstract
Background and Objectives
Acute myocardial infarction (AMI) occurring in patients at a young age (40 years or younger) is an uncommon condition and is characterized by multiple cardiovascular risk factors. We analyzed the risk factors of young-aged Korean AMI patients (age of 40 years or younger) and other AMI patients, who were registered in the Korea Acute Myocardial Infarction Registry (KAMIR) for one year.
Subjects and Methods
In 2006, 8,565 patients (mean age 64.4±12.7 years; 5,591 males) were registered in the KAMIR. The patients were divided into two groups: Group I (younger patients ≤40 years; n=261; mean age 35.9±4.5 years; 245 males) and Group II (older patients >40 years; n=8,304, mean age 65.4±11.8 years; 5,330 males). The clinical and angiographic characteristics and major adverse cardiac events (MACE) were compared for the two groups of patients.
Results
The baseline clinical characteristics of gender, age, risk factors (hypertension, smoking, diabetes, familial history) and body weight were different between the two groups (p<0.001). The baseline echocardiographic and laboratory findings of the initial ejection fraction, and the glomerular filtration rate, level of creatine kinase (CK), level of CK-MB isoenzyme, total cholesterol level, triglyceride level, and N-terminal prohormone brain natriuretic peptide (NT-proBNP) level were different between the two groups (p≤0.001). According to the use of multiple logistic regression analysis, use of thrombolysis [p=0.009, adjusted hazard ratio (aHR)=9.140, 95% confidence interval (CI): 1.727-48.383], a high blood glucose level (p=0.029, aHR=1.008, 95% CI: 1.001-1.016), a low body mass index (<25 kg/m2, p=0.031, aHR=6.236, 95% CI: 1.183-32.857), and a high CK-MB level and high Thrombolysis in Myocardial Infarction (TIMI) risk score were independent predictors of MACE at 1 year after an AMI in young age patients. Early clinical outcomes were better in Group I than in Group II patients, but one-, six-and twelve-month MACE were not different between the two groups.
Conclusion
The independent predictors of MACE at 1 year in young age AMI patients were the use of thrombolysis, a high blood glucose level, a low body mass index, a high CK-MB level and a high TIMI risk score. Patients that have had an acute myocardial infarction at a young age have a better early clinical outcome, but the long-term clinical outcomes were not different compared with older patients, and thus long-term intensive medical therapy will be required, even in young AMI patients.
Fig. 1
MACE-free survival during one-year follow-up. It was not different between the young and old aged patients [age≤40 (Group I) and age >40 (Group II)] (p<0.136 by the log-rank test). MACE: major adverse cardiac events.
Table 1
Baseline clinical characteristics
Table 2
Comparison of initial laboratory findings
Table 3
Comparison of previous and post-myocardial infarction medications between two groups
Table 4
Comparison of ECG presentations between two groups
Table 5
Independent predictors of major adverse cardiac events at one-year follow-up in the young age acute myocardial infarction
Table 6
Comparison of coronary angiographic findings
Table 7
Comparison of early clinical outcomes and MACE
References
-
Jeong PH, Lee JY, Yoo BS, et al. Acute myocardial infarction in the young adult. Korean Circ J 1998;28:8–12.
-
-
National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002;106:3143–3421.
-
-
Barbash GI, White HD, Modan M, et al. Acute myocardial infarction in the young: the role of smoking. Eur Heart J 1995;16:313–316.
-
-
Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction ): developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons: endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. Circulation 2007;116:e148–e304.
-
-
Cho JY, Jeong MH, Choi OJ, et al. Predictive factors after percutaneous coronary intervention in young patients with acute myocardial infarction. Korean Circ J 2007;37:373–379.
-
-
Lim SY, Jeong MH, Yang BR, et al. Long-term clinical outcomes after primary percutaneous coronary intervention in patients with acute myocardial infarction older than 75 years. Korean Circ J 2005;35:613–619.
-